Cardiac angiography is an examination procedure performed to detect medical disorders that occur in the heart's blood vessels. This procedure is one of the most common types of cardiac catheterization procedures performed.
Cardiac angiography or rather coronary angiography is performed using an X-ray machine and contrast fluid injected into the coronary arteries in the heart through the arm or groin. This procedure is able to produce a series of images that can show the location, severity, and number of coronary arteries that have a blockage in coronary heart disease.
Indications for Cardiac Angiography
Cardiac angiography is a part of cardiac catheterization that is generally performed when a patient has the following conditions:
- Chest pain (angina).
- Pain in the jaw, neck, or arms that cannot be explained by other examinations.
- An abnormal heart stress test (treadmill test).
- Heart defects from birth or having congenital heart disease.
- Heart valve disorders that require surgery.
- Vascular disorders or injuries to the chest.
- Heart failure.
- Heart attack diagnosed.
Because cardiac angiography has a risk of complications, this examination is usually not performed until other non-invasive heart tests have been performed, such as electrocardiography, echocardiography, or treadmill tests.
Warning:
- Be careful and tell your doctor if you have or have experienced an allergic reaction to contrast fluid, iodine, latex, or other substances contained in the anesthetic.
- Tell your doctor if you are taking drugs, supplements, or herbal products, especially blood-thinning drugs, such as warfarin. The doctor will advise the patient to stop using the drug 2-3 days before the procedure is performed. This is done to prevent the risk of heavy bleeding in the area of catheter insertion.
- Tell your doctor if you have a history of blood clotting disorders.
- Tell your doctor if you have kidney dysfunction. The use of contrast fluid during cardiac angiography risks damaging the kidney organs, especially in patients with weak kidney function.
- Tell your doctor if you are using a heart implant device, such as a pacemaker.
- Be careful and tell your doctor if you have diabetes. Ask your doctor when the right time to use insulin or other diabetes medications, such as metformin, before undergoing cardiac angiography.
- Tell your doctor if you are pregnant.
Before Cardiac Angiography
The doctor will explain to the patient about the heart angiography procedure that will be undertaken. Then, the patient will be given an consent form to be signed as a form of statement that the patient has understood the procedure and the risk of complications that may occur.
Furthermore, the patient will go through a health examination stage. The doctor will check the patient's medical history, including history of allergies and medications that are being consumed. The doctor will also do a physical examination and vital signs, including blood pressure and pulse.
The doctor will also instruct the patient to carry out several investigations, such as blood tests, chest X-rays, and electrocardiography (ECG). This action is done to ensure the patient's body is ready to undergo a cardiac angiography procedure.
In addition, there are several other things that patients need to do before undergoing a cardiac angiography procedure, including:
- Fasting for approximately 8 hours.
- Shaving the area around the groin.
- Invite a family member or colleague to accompany the patient before and after the procedure, and drive the patient home.
- Remove all jewelry, glasses, and contact lenses before undergoing the inspection procedure.
- The doctor or nurse will insert an IV tube into a vein in the patient's arm.
Cardiac Angiography Procedure
Cardiac angiography is performed in a special cardiac catheterization room equipped with several monitor screens. This procedure uses local anesthetics and sedatives which are given by injection. The following are the steps for a cardiac angiography procedure:
- The patient will be laid on his back on an examination table equipped with X-ray equipment.
- The doctor or nurse will install electrodes on the patient's chest connected to the monitor to monitor electrical activity in the patient's heart. Blood pressure gauges and gauges of the amount of oxygen in the blood (oximeter) will also be installed in the patient's body.
- The doctor or nurse starts giving a sedative through an IV tube so the patient will get sleepy during the procedure.
- The cardiologist will clean and sterilize the area where the catheter will be inserted, then numb the area by injecting local anesthetic.
- A small incision in the skin will be made to insert a long, flexible tube into the arteries.
- The catheter will be inserted through the flexible tube and directed slowly toward the heart arteries. The patient will feel a slight pressure on the incision when the catheter is inserted.
- The doctor will inject contrast fluid through the catheter into the arteries and chambers of the heart. This fluid will show the condition of blood vessels, heart valves, and heart chambers in detail. The patient will feel heat for a few seconds after a contrast fluid is injected.
- The X-ray machine quickly takes a series of images of the patient's heart condition. The doctor will instruct the patient to hold his breath when an X-ray is taken
After the cardiac angiography is completed, the doctor will remove the catheter from the patient's arm or groin, and close the incision with stitches and bandages. The doctor or nurse will put pressure on the incision to make sure there is no bleeding.
Cardiac angiography procedures can take 30-60 minutes or more, depending on medical disorders that occur in the patient's heart and the patient's overall condition.
After Heart Angiography
Next, the patient will be taken to the recovery room to undergo observation. After the doctor makes sure the patient's condition is stable, the patient will be taken to the treatment room and undergo a routine examination.
If the catheter is inserted through the groin, the patient is recommended to lie in the supine position and position the legs straight for 2-6 hours to prevent bleeding. During lying down, the position of the patient's head should not be too high because it can cause pressure on the abdomen and groin. The patient should not sit or stand until the doctor allows it.
If the catheter is inserted through the arm, the patient does not need to lie on his back. The patient will only go through a process of observation for a few hours to ensure the patient's condition is stable.
Patients are advised to consume lots of fluids to remove contrast fluid in the body through urine. The doctor will also give pain medication to relieve discomfort in the incision area.
After the patient undergoes the recovery process, the doctor can allow the patient to go home or encourage the patient to stay overnight for one night. The patient should be accompanied by a colleague or family member when returning home because the effects of drugs and sedatives do not allow the patient to drive the vehicle alone
During the recovery period at home, make sure there is someone who accompanied the patient for at least 24 hours. This is done because the patient will feel dizzy or experience mild headaches after undergoing cardiac angiography. In addition, the doctor will advise the patient to do the following:
- Get plenty of rest and consume fluids.
- Avoid smoking and drinking alcoholic beverages.
- Avoid driving or operating heavy equipment, for at least 24 hours after undergoing the procedure.
- Change the bandage after 24 hours.
- Keep the bandage from getting wet for at least 3 days.
- Do not apply lotion near the incision area, for at least 3 days after the procedure.
- Perform a condition and injury check a week after undergoing the procedure
Cardiac Angiography Results
Cardiac angiography examination can give two results, namely:
- Normal - if there is no blockage in the supply and flow of blood along the heart arteries.
- Abnormal - if a blockage is found in the heart arteries
Based on the results of cardiac angiography, doctors can diagnose heart problems experienced by patients and determine treatment therapies that are appropriate to the patient's condition. Some types of therapeutic treatments that can be done, including:
- Drugs. If the results of cardiac angiography show the patient has coronary heart disease, then the doctor will provide drugs to relieve symptoms and reduce the risk of heart attacks, such as aspirin, cholesterol-lowering drugs, beta blockers (beta blockers), calcium antagonists.
- Coronary angioplasty and ring fitting. The procedure is performed to increase blood flow to the heart by using special balloons, thereby opening up blocked arteries. Angioplasty is often accompanied by a ring to keep the arteries open.
- Heart bypass surgery. Surgical procedures are performed to create new blood flow by taking healthy blood vessels taken from other parts of the patient's body to replace the blocked arteries of the heart.
Risk of Cardiac Angiography
Cardiac angiography is a safe examination procedure performed. However, this procedure still has some risks that may occur. The following are some of the potential risks and complications that may occur although rarely occur, including:
- An allergic reaction to contrast fluid or drugs used during the procedure.
- Infection.
- Bleeding.
- Heart attack.
- Stroke.
- Arrhythmia.
- Kidney damage.
- Heart tamponade.
- Injury to the heart arteries.
Contact your doctor immediately to get emergency treatment if you experience the following conditions:
- Fever or chills.
- Pain, redness, swelling, or bleeding in the incision area.
- Numbness or tingling in the arms or legs.
- Pain or pressure in the chest.
- Nausea and vomiting.
